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General NPI Number Information
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NPI Number | 1245876325
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Entity Type | Individual
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Provider Name | DAMIAN DAVID DAFFARA COO
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Gender | Male
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Dates
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Enumeration Date | 11/23/2019
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Last Update Date | 11/23/2019
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Provider Practice Location Address
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Address Line | 355 BLOOMFIELD AVE
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City | CALDWELL
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State | NJ
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Zip | 07006-5118
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Country | US
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Telephone | 973-228-0072
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Fax | 973-228-2311
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Provider Business Mailing Address
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Address Line | 69 NICHOLAS AVE
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City | WEST ORANGE
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State | NJ
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Zip | 07052-2932
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Country | US
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Telephone | 917-783-4554
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Fax | 973-325-1720
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246YR1600X
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Taxonomy Name | Registered Record Administrator
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License Number |
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License Number State |
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